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The Critical Role of Volunteers in Hospice Settings

Clint Maun, CSP

Due to rising medical and healthcare costs and a continually growing elderly population, hospice care has become an increasingly popular and accepted alternative for terminally ill patients. According to the National Hospice Organization, hospice is defined as a model for quality, compassionate care at the end of life. Patients typically are referred to hospice when they have less than six months to live, and decide to forego more curative medical efforts. Therefore, the goal of hospice isn’t necessarily to prolong a patient’s life, but rather to provide the best quality of life for the patient and for the patient’s family.

Hospice patients can be cared for in their own homes, as well as in hospitals, nursing homes, or long-term care facilities. Hospice care involves a team-oriented approach to pain management. A hospice team often consists of the following roles and members:

Medical Director: collaborates with all hospice members to ensure that every patient and family need is being addressed.

Patient Physician: addresses the patient’s medical needs and maintains a relationship with the patient and family.

RN:  coordinates the patient’s care, communicates with attending physicians and other members of the team, assesses the patient’s and family’s needs, and supervises care in the patient’s home and other settings.

Social Worker: helps patients and families access community resources and provides counseling for death-related issues, including communication problems, anticipatory grief, bereavement issues, and follow-up grief and bereavement.

Pastoral Care: (i.e., clergy, minister, rabbi, religious minister, etc.). Clergy address spiritual and religious issues, coordinate and/ or provide spiritual interventions, and offer spiritual support for patient and family members.

Certified Nurse Assistant (C.N.A.):  bathes patients, assists with activities of daily living, offers comfort measures, and reports changes in patient’s and family’s condition.

Family Members: usually the primary caregivers.

Community Members: often serve as volunteers who provide respite care for family members and perform various tasks, such as grocery shopping, errands, etc.

Collectively, hospice members provide emotional and spiritual support tailored to the patient’s needs and wishes. Patients and families are often attracted by the individual attention of hospice team members who make every effort to help make them feel more comfortable and at ease with their situation.

Volunteers: Helping the Institution & the Patient
When patients are diagnosed with a terminal illness and placed in hospice care, they often experience a shift and/or disruption in their network of relationships. Friends and family members may avoid interacting with the patient due to feelings of inadequacy and anxiety. This disruption in a patient’s personal network is a major reason why volunteers were incorporated into the system of hospice support.

Volunteers have a unique position in a hospice patient’s support network because they are not bound as tightly to the organizational or bureaucratic system as are the patient’s professional healthcare providers. At the same time, volunteers usually don’t carry the emotional and relational burdens that the patient’s personal network must bear. This unique position places volunteers in a role of being both an informal (part of a network of friends and family) and formal support provider (part of a professional healthcare system).

Hospice volunteers provide several services and fill various roles. Volunteers can provide companionship to patients through listening, reading, music, prayer, holding a hand, and just “being there”. Hospice volunteers also frequently provide instrumental support to patients and their families by offering respite care, which allows the patient’s primary caregiver a chance to run errands or have an afternoon off. Volunteers can also provide support at the time of death and during bereavement.

Volunteer service is considered so vital to hospice that Federal Medicare guidelines require that at least five percent of the hospice’s care be provided by volunteers. They are truly an intricate part of the hospice care continuum.

Finding the Right People
It takes a strong and compassionate person to fill the role of hospice volunteer. Indeed, the hospice volunteer must be prepared to help patients and families with what is most likely the hardest and most uncertain time of their lives. Therefore, recruiting the “right” volunteer is crucial. A healthcare facility definitely doesn’t want to recruit volunteers who aren’t a good fit, and the patient and family certainly don’t have time to deal with someone who is uncommitted to this critical role.

Healthcare facilities must be concise and clear when recruiting hospice volunteers. Organizations will want to provide prospective volunteers with all the involved duties and roles. Additionally, you’ll want to make sure that the volunteer is aware of the emotional toll hospice service can take.

A good hospice volunteer usually displays distinctive traits. A person who is well-equipped for the position usually demonstrates the following:
  • Is patient and non-judgmental
  • Is comfortable with silence
  • Is honest about their own time and energy limits
  • Is respectful of others’ beliefs and spiritual needs
Additionally, the Myers-Briggs-type personality profiles of hospice volunteers show that hospice volunteers are more apt to be extroverted than introverted, more feeling than thinking, and rely more on intuition over sensing. Hospice volunteers also tend to report themselves as being low in communication anxiety and high in empathy. Empathy is a particularly important characteristic for hospice workers because it lines up with the value of holistic treatment—caring for emotional and psychological needs as well as physical ones.

Delivering the Right Training
The training that a hospice volunteer requires is dependent upon the role the volunteer will play. Those volunteers serving in a role that does not involve patient care require only training to perform the specific task that they will be involved in while supporting the hospice. These volunteers, often referred to as administrative/general support volunteers, may work in the office assisting with administrative tasks, assisting with fundraising campaigns and events, or possibly working in the kitchen in some capacity. These are generally tasks that involve little or no interaction with the dying person or their family but are very important to hospice operations. Their training would also include any general policies and procedures training of the agency, such as fire and safety training.

Those who serve in the role of direct patient care and family support often referred to as patient care volunteers, require specialized training in order to acquire all of the skills and competencies necessary. For example, there are many sensitive issues to be aware of and communications skills to be learned. This is where hospice volunteer training is instrumental in preparing a prospective volunteer to serve the dying and their families.

Volunteer training typically lasts 20-30 hours, spread over several weeks. The National Hospice and Palliative Care Organization (HPCO) offers a useful volunteer tool that organizations may want to leverage. The Hospice Volunteer Program Resource Manual is a comprehensive guide for hospice volunteers and volunteer managers. It comes with several ready-to-use forms, such as competency checklists, surveys, a policies and procedures form, visit logs, and other administrative forms.

You can learn more by visiting HPCO’s Web site at:
http://www.nhpco.org

Always Keep a Focus on Volunteers
Trends indicate that as more patients and families become educated about its many benefits, hospice is growing as an attractive alternative to facing death in a clinical setting. So, as hospice care continues to grow, it’s important that volunteers remain a key part of the hospice team. Not only do they provide a cost-effective role, but they also provide dying patients with the care, attention, and support they often seek. Clearly, hospices that recruit the right volunteers and deliver the right training will be more likely to strengthen their organization’s efforts to achieve its mission in providing quality hospice care.

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